Lack of Acute, Long-Term Care Continuity Harming Patients

Healthcare today desperately needs to improve the quality of care provided to patients. Success in raising the quality bar requires healthcare stakeholders understand the emerging changes in payment reform and care delivery, including how technology is being used to assist in care coordination and quality. Speakers at Tuesday’s Long-Term and Post-Acute Care Health IT Summit’s Town Hall session urged the audience to focus on using technology to support and improve continuity of care.

The problem with today’s environment, participants in the Town Hall said, is that acute care physicians do not always understand what happens to patients in long-term care, rehab, or home health facilities, and vice versa.

Lack of Connectivity Causing Readmissions

Town Hall speaker Bill Russell, MD, medical director, Virginia, at JenCare Medical, impressed upon the audience that long-term care is “a critical healthcare environment.” Russell said that an increased trust between the patient and provider “brings the knowledge back to the medical provider and allows for better treatment of care.” In addition to better patient engagement and connectivity between providers, Russell said better industry utilization of information technology interoperability, electronic health record systems (EHRs), and technology automation can also help influence healthcare decisions.

Hospital readmissions—an effect of disjointed continuity of care between acute and long-term care—continue to disturb the healthcare landscape. According to a 2013 Health Affairs article, one in five elderly patients will wind up back in the hospital within 30 days of discharge. The cost of readmissions is staggering, with $26 billion annually spent by healthcare institutions, of which $17 billion is spent on return trips that could have been prevented, the article stated. Care coordination that works to decrease readmissions is the key for a successful long term healthcare transformation.

Transitions to and from acute and post-acute settings are common and can be very costly. According to the Centers for Medicare and Medicaid Services’ (CMS) “Health IT in Long-term and Post Acute Care Issue Brief” in 2008 38.7 percent of all Medicare beneficiaries discharged from acute care hospitals received post-acute care.Of these beneficiaries, 15.5 percent were readmitted to the acute care hospital within 30 days. Ensuring timely and—more importantly—appropriate communication among providers can be a key factor in ensuring the delivery of quality care.

In addition, Medicare beneficiaries using post-acute care services often use multiple post-acute care sites within 60 days of an acute care hospital discharge. Larry Wolf, MS, a health IT strategist at Kindred Healthcare, validated these challenges stating “it is not uncommon for patients to be in multiple post-acute services, and it would be great if the information in shared assessments is actually helpful to each care provider.”

Medicaid’s Role in Connecting Long-Term Care

Anita Yuskauskas, PhD, the technical director for HCBS quality at CMS, provided the Town Hall audience greater insight into Medicaid recipients, reporting that “Medicaid is the largest payer in the long-term care environment.” As state-level entities spread across the US there was no single standard requirement, resulting in multiple models and structures for this payer. Medicaid is a decentralized environment with a wide array of home-based settings and providers. Yuskauskas said that CMS’ vision for the Medicaid portion of the “meaningful use” EHR Incentive Program is an “e-health connected Medicaid health system.”

There are multiple settings within the LTPAC community, and although the continuity of care document (CCD) standard has been developed to specify the structure and semantics of a patient summary document, it may not be enough information. The average CCD document has 175 pieces of information and acute care organizations concerned with the narrow focus of stage 2 meaningful use criteria may not realize that home health agencies need up to 375 pieces of information, according to Lawrence Garber, MD, an internal medicine physician at Reliant Medical Group, who spoke at the Town Hall.

Treat Patients, Not Computers

There is an opportunity for technology to fill the gap between care settings because EHRs are the start of the connectivity. Once the infrastructure is in place, innovative software is required to truly connect providers and settings. Presenter Brian Yeaman, MD, CEO of Yeaman and Associates, emphasized to the audience that physicians “do not want to treat computers and then treat patients.”

True care coordination involves the deliberate organization of patient care processes and subsequent sharing of information among all members of the continuum of care to achieve safer and more effective healthcare. This means that individual patient needs and preferences are known in advance and communicated at the right time to the appropriate provider with information geared towards providing safe, appropriate care to that patient.

Wolf focused his Town Hall presentation on the Office of the National Coordinator for Health IT’s (ONC) EHR certification program, stressing to attendees “the heart of ONC certification is for all providers to provide a seamless transition of care, ensure privacy and security of information, and supply data integration.”

Coordination Burden Currently on Patient

Sharing information is a critical element to care coordination. In some instances, to electronically share information from setting to setting or provider to provider is extremely difficult. Instead, it is often up to the patient to know which information is important, and share it appropriately to his or her multiple care providers. This is not a viable solution given the complexity of today’s healthcare environment and adds to a patient’s anxiety.